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Imaging spectrum of traumatic urinary bladder and urethral injuries

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Abstract

Urinary bladder and urethral injuries usually occur as part of multiple injuries in polytrauma patients. These injuries are easily overlooked because the initial evaluation is focused on other life-threatening injuries such as traumatic brain injury, hemopneumothorax or hemoperitoneum. Although the urinary bladder and urethral injuries are not life-threatening, they pose the risk of long-term morbidity which can be burdensome. These complications include urinary incontinence, voiding dysfunction, urethrocutaneous fistula, urethral stricture and erectile dysfunction. Computed tomography (CT) findings of urinary bladder and urethral injuries are usually subtle. Retrograde fluoroscopic/CT cystography and urethrography remain the mainstay imaging techniques for complete evaluation, diagnosis, staging, and follow-up of these traumatic injuries. In this review, we discuss the pathophysiology and imaging spectrum of urinary bladder and urethral injuries with an emphasis on the classification schemes. Familiarity with the pelvic anatomy and the injury pattern leads to the prompt diagnosis, accurate classification and appropriate management, which have been associated with better prognosis.

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References

  1. Urry RJ, Clarke DL, Bruce JL, Laing GL (2016) The incidence, spectrum and outcomes of traumatic bladder injuries within the Pietermaritzburg Metropolitan Trauma Service. Injury 47:1057-1063.

    CAS  PubMed  Google Scholar 

  2. Matlock KA, Tyroch AH, Kronfol ZN, McLean SF, Pirela-Cruz MA (2013) Blunt traumatic bladder rupture: a 10-year perspective. Am Surg 79:589-593.

    PubMed  Google Scholar 

  3. Barnard J, Overholt T, Hajiran A, Crigger C, Jessop M, Knight J, Morley C (2019) Traumatic bladder ruptures: a ten-year review at a level 1 trauma center. Adv Urol 2019:2614586.

    PubMed  PubMed Central  Google Scholar 

  4. Paparel P, N'Diaye A, Laumon B, Caillot JL, Perrin P, Ruffion A (2006) The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43,000 victims. BJU Int. 97:338-341.

    PubMed  Google Scholar 

  5. Bhatt NR, Merchant R, Davis NF, Leonard M, O'Daly BJ, Manecksha RP, Quinlan JF (2018) Incidence and immediate management of genitourinary injuries in pelvic and acetabular trauma: a 10-year retrospective study. BJU Int 122:126-132.

    PubMed  Google Scholar 

  6. Alwaal A, Zaid UB, Blaschko SD, Harris CR, Gaither TW, McAninch JW, Breyer BN (2015) The incidence, causes, mechanism, risk factors, classification, and diagnosis of pelvic fracture urethral injury. Arab J Urol 13:2-6.

    PubMed  Google Scholar 

  7. Ziran BH, Chamberlin E, Shuler FD, Shah M (2005) Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma 58:533-537.

    PubMed  Google Scholar 

  8. Gomez RG, Ceballos L, Coburn M, Corriere JN, Dixon CM, Lobel B, McAninch J (2004) Consensus statement on bladder injuries. BJU International 94:27-32.

    PubMed  Google Scholar 

  9. Ingram MD, Watson SG, Skippage PL, Patel U (2008) Urethral injuries after pelvic trauma: evaluation with urethrography. Radiographics 28:1631-1643.

    PubMed  Google Scholar 

  10. Doiron RC, Rourke KF (2019) An overview of urethral injury. Can Urol Assoc J 13:S61-S66.

    PubMed  PubMed Central  Google Scholar 

  11. Ali M, Safriel Y, Sclafani SJ, Schulze R (2003) CT signs of urethral injury. Radiographics 23:951-963; discussion 63-66.

  12. Goldman SM, Sandler CM, Corriere JN, Jr., McGuire EJ (1997) Blunt urethral trauma: a unified, anatomical mechanical classification. J Urol 157:85-89.

    CAS  PubMed  Google Scholar 

  13. Chan DP, Abujudeh HH, Cushing GL, Jr., Novelline RA (2006) CT cystography with multiplanar reformation for suspected bladder rupture: experience in 234 cases. AJR Am J Roentgenol 187:1296-1302.

    PubMed  Google Scholar 

  14. Power N, Ryan S, Hamilton P (2004) Computed tomographic cystography in bladder trauma: pictorial essay. Can Assoc Radiol J 55:304-308.

    PubMed  Google Scholar 

  15. Phillips B, Holzmer S, Turco L, Mirzaie M, Mause E, Mause A, Person A, Leslie SW, Cornell DL, Wagner M, Bertellotti R, Asensio JA (2017) Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis. Eur J Trauma Emerg Surg 43:763-773.

    CAS  PubMed  Google Scholar 

  16. Ramchandani P, Buckler PM (2009) Imaging of genitourinary trauma. AJR Am J Roentgenol 192:1514-1523.

    PubMed  Google Scholar 

  17. Rehm CG, Mure AJ, O'Malley KF, Ross SE (1991) Blunt traumatic bladder rupture: the role of retrograde cystogram. Ann Emerg Med 20:845-847.

    CAS  PubMed  Google Scholar 

  18. Cass AS (1984) The multiple injured patient with bladder trauma. J Trauma 24:731-734.

    CAS  PubMed  Google Scholar 

  19. Hsieh CH, Chen RJ, Fang JF, Lin BC, Hsu YP, Kao JL, Kao YC, Yu PC, Kang SC (2002) Diagnosis and management of bladder injury by trauma surgeons. Am J Surg 184:143-147.

    PubMed  Google Scholar 

  20. Johnsen NV, Dmochowski RR, Young JB, Guillamondegui OD (2017) Epidemiology of blunt lower urinary tract trauma with and without pelvic fracture. Urology 102:234-239.

    PubMed  Google Scholar 

  21. Gross JS, Rotenberg S, Horrow MM (2014) Resident and fellow education feature. Bladder injury: types, mechanisms, and diagnostic imaging. Radiographics 34:802-803.

    PubMed  Google Scholar 

  22. Expert panel on urological imaging, Heller MT, Oto A, Allen BC, Akin O, Alexander LF, Chong J, Froemming AT, Fulgham PF, Mackenzie DC, Maranchie JK, Mody RN, Patel BN, Schieda N, Turkbey IB, Venkatesan AM, Wang CL, Lockhart ME (2019) ACR Appropriateness Criteria® penetrating trauma-lower abdomen and pelvis. J Am Coll Radiol 16:S392-S398.

    Google Scholar 

  23. Expert panel on major trauma imaging, Shyu JY, Khurana B, Soto JA, Biffl WL, Camacho MA, Diercks DB, Glanc P, Kalva SP, Khosa F, Meyer BJ, Ptak T, Raja AS, Salim A, West OC, Lockhart ME (2020) ACR Appropriateness Criteria® major blunt trauma. J Am Coll Radiol 17:S160-S174.

    Google Scholar 

  24. Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, Erickson BA, Holzbeierlein J, Hudak SJ, Pruitt JH, Reston JT, Santucci RA, Smith TG 3rd, Wessells H (2017) Urotrauma: AUA guideline 2017. Available from: https://www.auanet.org/guidelines/urotrauma-guideline. Accessed 10 December 2019.

  25. Kitrey ND, Djakovic N, Serafetinides E, Lumen N, Hallscheidt P, Kuehhas FE, Sharma DM, Sujenthiran A, Abu-Ghanem Y, Waterloos M (2019) EAU guidelines on urological trauma 2019. Available from: https://uroweb.org/guideline/urological-trauma/. Accessed 10 December 2019

  26. Iverson AJ, Morey AF (2001) Radiographic evaluation of suspected bladder rupture following blunt trauma: critical review. World J Surg 25:1588-1591.

    CAS  PubMed  Google Scholar 

  27. Shin SS, Jeong YY, Chung TW, Yoon W, Kang HK, Kang TW, Shin HY (2007) The sentinel clot sign: a useful CT finding for the evaluation of intraperitoneal bladder rupture following blunt trauma. Korean J Radiol 8:492-497.

    PubMed  PubMed Central  Google Scholar 

  28. Haas CA, Brown SL, Spirnak JP (1999) Limitations of routine spiral computerized tomography in the evaluation of bladder trauma. J Urol 162:51-52.

    CAS  PubMed  Google Scholar 

  29. Quagliano PV, Delair SM, Malhotra AK (2006) Diagnosis of blunt bladder injury: a prospective comparative study of computed tomography cystography and conventional retrograde cystography. J Trauma 61:410–421; discussion 421–422.

  30. Deck AJ, Shaves S, Talner L, Porter JR (2000) Computerized tomography cystography for the diagnosis of traumatic bladder rupture. J Urol 164:43-46.

    CAS  PubMed  Google Scholar 

  31. Morey AF, Iverson AJ, Swan A, Harmon WJ, Spore SS, Bhayani S, Brandes SB (2001) Bladder rupture after blunt trauma: guidelines for diagnostic imaging. J Trauma 51:683-686.

    CAS  PubMed  Google Scholar 

  32. Wirth GJ, Peter R, Poletti PA, Iselin CE (2010) Advances in the management of blunt traumatic bladder rupture: experience with 36 cases. BJU Int 106:1344-1349.

    PubMed  Google Scholar 

  33. Wu TS, Pearson TC, Meiners S, Daugharthy J (2011) Bedside ultrasound diagnosis of a traumatic bladder rupture. J Emerg Med 41:520-523.

    PubMed  Google Scholar 

  34. Karim T, Topno M, Sharma V, Picardo R, Hastir A (2010) Bladder injuries frequently missed in polytrauma patients. Open Access J Urol 2:63-65.

    PubMed  PubMed Central  Google Scholar 

  35. Moore EE, Cogbill TH, Jurkovich GJ, McAninch JW, Champion HR, Gennarelli TA, Malangoni MA, Shackford SR, Trafton PG (1992) Organ injury scaling. III: chest wall, abdominal vascular, ureter, bladder, and urethra. J Trauma 33:337-339.

    CAS  PubMed  Google Scholar 

  36. Sandler CM, Hall JT, Rodriguez MB, Corriere JN Jr (1986) Bladder injury in blunt pelvic trauma. Radiology 158:633-638.

    CAS  PubMed  Google Scholar 

  37. Simon LV, Sajjad H, Lopez RA, Bracken B (2020) Bladder Rupture. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470226/. Accessed 28 April 2020.

  38. Stern N, Pignanelli M, Welk B (2019) The management of an extraperitoneal bladder injury associated with a pelvic fracture. Can Urol Assoc J 13:S56-S60.

    PubMed  PubMed Central  Google Scholar 

  39. Vaccaro JP, Brody JM (2000) CT cystography in the evaluation of major bladder trauma. Radiographics 20:1373-1381.

    CAS  PubMed  Google Scholar 

  40. Cass AS (1984) False negative retrograde cystography with bladder rupture owing to external trauma. J Trauma 24:168-169.

    CAS  PubMed  Google Scholar 

  41. Morsbach F, Bickelhaupt S, Wanner GA, Krauss A, Schmidt B, Alkadhi H (2013) Reduction of metal artifacts from hip prostheses on CT images of the pelvis: value of iterative reconstructions. Radiology 268:237-244.

    PubMed  Google Scholar 

  42. Han SC, Chung YE, Lee YH, Park KK, Kim MJ, Kim KW (2014) Metal artifact reduction software used with abdominopelvic dual-energy CT of patients with metal hip prostheses: assessment of image quality and clinical feasibility. AJR Am J Roentgenol 203:788-795.

    PubMed  Google Scholar 

  43. Katsura M, Sato J, Akahane M, Kunimatsu A, Abe O (2018) Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists. Radiographics 38:450-461.

    PubMed  Google Scholar 

  44. Neuhaus V, Grosse Hokamp N, Zopfs D, Laukamp K, Lennartz S, Abdullayev N, Maintz D, Borggrefe J (2019) Reducing artifacts from total hip replacements in dual layer detector CT: combination of virtual monoenergetic images and orthopedic metal artifact reduction. Eur J Radiol 111:14-20.

    PubMed  Google Scholar 

  45. Sandler CM, Goldman SM, Kawashima A (1998) Lower urinary tract trauma. World J Urol 16:69-75.

    CAS  PubMed  Google Scholar 

  46. Basta AM, Blackmore CC, Wessells H (2007) Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol 177:571-575.

    PubMed  Google Scholar 

  47. Myers JB, McAninch JW (2009) Management of posterior urethral disruption injuries. Nat Clin Pract Urol 6:154-163.

    PubMed  Google Scholar 

  48. Ku J, Kim ME, Jeon YS, Lee NK, Park YH (2002) Management of bulbous urethral disruption by blunt external trauma: the sooner, the better? Urology 60:579-583.

    PubMed  Google Scholar 

  49. Lee B, Vangipuram R, Petersen E, Tyring SK (2018) Complications associated with intimate body piercings. Dermatol Online J 24.

  50. Meltzer DI (2005) Complications of body piercing. Am Fam Physician 72:2029-2034.

    PubMed  Google Scholar 

  51. Pariser JJ, Pearce SM, Patel SG, Bales GT (2015) National patterns of urethral evaluation and risk factors for urethral injury in patients with penile fracture. Urology 86:181-185.

    PubMed  Google Scholar 

  52. Hota P, Patel T, Patel H, Conn C, Sterling ME, Metro M, Agosto O (2020) Post-traumatic retrograde urethrography: a review of acute findings and chronic complications. Appl Radiol 49:24-31.

    Google Scholar 

  53. Amer T, Wilson R, Chlosta P, AlBuheissi S, Qazi H, Fraser M, Aboumarzouk OM (2016) Penile Fracture: a meta-analysis. Urol Int 96:315-329.

    PubMed  Google Scholar 

  54. Cass AS, Gleich P, Smith C (1984) Simultaneous bladder and prostatomembranous urethral rupture from external trauma. J Urol 132:907-908.

    CAS  PubMed  Google Scholar 

  55. Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N, Pansadoro V, McAninch JW (2004) Consensus statement on urethral trauma. BJU Int 93:1195-1202.

    CAS  PubMed  Google Scholar 

  56. Colapinto V, McCallum RW (1977) Injury to the male posterior urethra in fractured pelvis: a new classification. J Urol 118:575-580.

    CAS  PubMed  Google Scholar 

  57. Frankman EA, Wang L, Bunker CH, Lowder JL (2010) Lower urinary tract injury in women in the United States, 1979-2006. Am J Obstet Gynecol 202:495.e1-495.e5.

    Google Scholar 

  58. Bjurlin MA, Fantus RJ, Mellett MM, Goble SM (2009) Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma 67:1033-1039.

    PubMed  Google Scholar 

  59. Perry MO, Husmann DA (1992) Urethral injuries in female subjects following pelvic fractures. J Urol 147:139-143.

    CAS  PubMed  Google Scholar 

  60. Patel DN, Fok CS, Webster GD, Anger JT (2017) Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU Int 120:766-773.

    PubMed  Google Scholar 

  61. Battaloglu E, Figuero M, Moran C, Lecky F, Porter K (2019) Urethral injury in major trauma. Injury 50:1053-1057.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Sirote Wongwaisayawan

  2. Depertment of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada

    Sirote Wongwaisayawan, Adnan Sheikh & Nicola Schieda

  3. Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada

    Satheesh Krishna

  4. Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Rathachai Kaewlai

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  1. Sirote Wongwaisayawan
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  2. Satheesh Krishna
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Wongwaisayawan, S., Krishna, S., Sheikh, A. et al. Imaging spectrum of traumatic urinary bladder and urethral injuries. Abdom Radiol 46, 681–691 (2021). https://doi.org/10.1007/s00261-020-02679-0

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